A pulmonary embolism (PE) occurs when tanks a venous thrombotic material from the lower extremities embolizes to the pulmonary vasculature.Common presenting symptoms include shortness of breath and pleuritic chest pain with vital signs Vacuum Sealers demonstrating hypoxia, tachycardia, and tachypnea.In this paper, we describe a unique presentation of a critically ill patient who developed a saddle pulmonary embolism despite being on prophylactic anticoagulation.